1. Nutrition & Cardiovascular Disorders

2. Cardiovascular diseases  Hypertension  Ischemic heart disease Angina pectoris Myocardial infarction

3. Athrosclerosis  Artery walls become progressively thickened due to accumulation of plaque  Occurs due to minimal but chronic injuries that damage the inner arterial wall

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5. Consequences Lumen narrows Plaque can rupture, forming a clot (thrombus) Thrombus can break free & shut off blood flow (embolism) Ischemia occurs within the tissue – Coronary arteries (angina pectoris & heart attack) – Brain (stroke) Aneurysm (sac-like distention of blood vessel wall)

6. Coronary Heart Disease Most common type Leading cause of death in U.S. Evaluating Risk – Smoking – High LDL – High blood pressure – Diabetes – Obesity – Inactivity Non-modifiable risk factors – Age – Male gender – Family history

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9. Lifestyle Changes for CHD Cholesterol-lowering diet (<200 mg) Weight reduction Regular physical activity Decrease saturated fat <7% total kcalories Decrease total fat 25-35% of kcalories Decrease trans fat Increase soluble fiber Plant sterols & stanols Eat soy products Increase fish & omega-3 fatty acids

10. Vitamin Supplementation No conclusive research results have been obtained for vitamins being preventative for CVD Study is underway for increasing: – Folate, vitamin B 6 & B 12 to decrease homocysteine levels – Vitamin C and E for antioxidant effects

11. Myocardial Infarction: Diet: For 24 to 48 hours the patient is only given parenteral dextrose and no food is given by mouth, but sips of cool water are given. After that low fat liquid diet (500 to 800 calories and 1000- 1500 ml fluid diet) is given in very small feeds for 2 to 3 days. The patient -progresses to a soft diet (about 1000-1200 calories), which may help establish circulation needed for digestion and absorption of food.

12. The diet is given in five or six easily digestible meals. The fat content of the diet is less than 30 per cent of total calories, with less than 300mg cholesterol and less than 10 per cent calories from saturated fat. The sodium is restricted to less than 1000 mg for a congestive heart failure patient, while it may be mild for less serious condition. Gas producing foods as per patient’s perception are avoided. In edema cases fluid is restricted

13. Congestive Heart Failure Heart’s inability to pump adequate blood Fluids build up in veins & tissues Heart enlarges 75% are 65 or older Consequences – Fluid accumulation in liver, abdomen, & lower extremities – Chest pain; swelling legs, ankles, feet; SOB – Impaired liver & kidneys – Heart failure – Cardiac cachexia

14. Congestive Heart Failure: Diet: The workload of heart must be reduced. The dietary progression is similar to that given for myocardial infarction. In addition severe sodium restriction (500 – 1000 mg) and fluid restriction may be advisable.

15. Medical Management  Sodium & fluid restrictions  Diuretics  Small, frequent meals  Vaccinations for influenza & pneumonia  Adequate fiber  Avoid alcohol  Liquid supplements, tube feedings, parenteral support © 2007 Thomson - Wadsworth

16. Hypertension Affects 1/3 of adults in U.S. Factors influencing BP – Cardiac output – Peripheral resistance – Secretion of hormones by kidneys Desirable BP – < 120/80 Prehypertension – 120-139/80-89 Hypertension – > 140/90

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18. Contributing Factors Aging Genetics – More prevalent in African Americans Obesity – Alters kidney function & promotes fluid retention Salt sensitivity – 30-50% of cases Alcohol Diet – Fruits, vegetables, nuts, low-fat milk can lower BP – Potassium, calcium, & magnesium can lower BP

19. Treatment of Hypertension Weight reduction Low-sodium diet Diet rich in potassium, calcium, & magnesium Regular physical activity Moderate alcohol DASH Diet - Limits: – Red meats – Sweets – Sugar-containing beverages – Saturated fat to <7% – Cholesterol to 150 mg/day Drug therapy

20. Diet Therapy  Hypertension may be often due to obesity dietary changes which result in weight loss will lead to reduction in blood pressure.  The second possibility is excessive sodium intake, which draws more water into circulation, thus increasing blood volume, leading to increased blood pressure.

21. In patients, whose only problem is mild hypertension, diet therapy without use of drugs is used to achieve control. This includes: (a)Moderate sodium restriction ( 1000-1500 mg/day): No salt in cooking or at the table. (b) Adequate potassium intake: Plant foods are rich sources of potassium, especially fruits and vegetables. (c) Regular exercise tailored to the individual is a must – walking 5 kilometres daily has been found to be an ideal way to keep fit. (d) Stress management: is a very important aspect of therapy. It involves regular planning of one’s activities allowing realistic scheduling of work, relaxation, physical activity, mealtimes.

22. Sources of Sodium in the Diet  Most plant foods are low in sodium.  Animal foods – meat, fish and poultry are naturally high in sodium. Eggs are especially high in sodium (most of sodium is in the egg white).

23. Food Preparation for Sodium Restricted Diet  It takes about 3 months to get used to a sodium restricted diet. By that time the taste preference for salt decreases.  Use of spices, herbs, flavor extracts helps to improve acceptance of salt less recipe. These include lemon juice, pepper, green pepper, onion, garlic etc., which may be used in vegetables, stews and salads.

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26. To Achieve An Overall Healthy Eating Pattern  Choose an overall balanced diet with foods from all major food groups, emphasizing fruits, vegetables and grains.  Consume a variety of fruits, vegetables and grain products. At least 5 daily servings of fruits and vegetables. At least 6 daily servings of grain products, including whole grains.  Include fat-free and low-fat dairy products, fish, legumes, poultry and lean meats. Eat at least two servings of fish per week. Summary of American Heart Association Dietary Guidelines

27. To Achieve A Healthy Body Weight  Avoid excess intake of calories.  Maintain a level of physical activity that achieves fitness and balances energy expenditure with caloric intake; for weight reduction, expenditure should exceed intake.  Limit foods that are high in calories and/or low in nutritional quality, including those with a high amount of added sugar.

28. To Achieve A Desirable Cholesterol Level  Limit foods with a high content of saturated fat and cholesterol. Substitute with grains and unsaturated fat from vegetables, fish, legumes and nuts.  Limit cholesterol to 300 milligrams (mg) a day for the general population, and 200 mg a day for those with heart disease or its risk factors.  Limit trans fatty acids. Trans fatty acids are found in foods containing partially hydrogenated vegetable oils such as packaged cookies, crackers and other baked goods; commercially prepared fried foods and some margarines

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30. Sodium vs. Potassium © 2007 Thomson - Wadsworth

31. Potassium © 2007 Thomson - Wadsworth